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Girls and Women who have ASD

Profile of Abilities in Girls and Women• The invisible end of the spectrum (Ruth

Baker)• Have more advanced social skills than

the boys• Girls have fewer, but perceive more

Aspie features than males• Fly under the radar of a diagnosis• Coping and camouflaging mechanisms

of observation, analysis and imitating

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Profile of Abilities in Girls• Observe and try to understand before

they make the first step• Over-analyzing social situations (analysis

to paralysis)• Becoming a child psychologist• Reading fiction (or watching soap operas)

helps learn about inner thoughts and feelings

Profile of Abilities in Girls• Decode social situations in doll play and

talking with imaginary friends• Apologize and appease• Chameleon

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Imitation

• Observation and absorption of the speech, mannerisms and character, even persona of someone who is socially successful.

• Becoming an expert mimic (successful strategy that is popular with peers).

• Using speech and drama lessons.• Tendency to be more animated when pretending than

the real person

Imitation

• For a brief while, ‘cured’ of autism• Surface sociability but a lack of social identity• Masquerading: watch and imitate to conceal social confusion• Source of anxiety and stress• Lack of self-identity• Inconspicuous so stress related mental health concerns are not

noticed in school

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Imitation

• I have done such a great job at pretending to be normal that nobody really believes I have Asperger’s.

• Playing with personalities• Why go to all the effort of figuring out what is normal

is, when you can just copy it• For a brief while ‘cured’ of ASD• Boys are little professors, girls, little psychologists

The Mask• Emily masks in public and will meltdown the second

she is out of the situation.• Dr Jekyll and Mr Hyde.

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Profile of Abilities in Girls• Less disruptive and so less likely to be noticed• We think that if we are very, very good, people will

like us and all will be well• Learn that if you are good, you are left alone• Learn if you are quiet no one sees you

Interests of Girls

• Intensity rather than focus• Dolls to replay and decode social situations• Literature• Being feminine • Nature and animals• Friendship

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New Questionnaire

• Questionnaire of Autism Spectrum Conditions• Designed and developed by Attwood, Garnett and Rynkiewicz in

2011• 57 items• Age 5-19

2012-2013EN

GQ-ASC development

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Q-ASC

• Does she prefer to play with boys toys?• Does she play with imaginary friends and animals?• Does she create and enjoy fantasy worlds?• Does she prefer to play and talk with boys?• Does she avidly observe other girls playing and socializing?

Q-ASC

• Does she copy or ‘clone’ herself on other girls?• Does she have a facial mask that hides her social confusion?• Do some social situations make her mute?• Does she socialize well but subsequently feel exhausted?• Is she talented in languages and singing?

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Q-ASC

• Is she interested in looking feminine?• Are her interests advanced for her age (e.g., opera or Shakespeare• Does she have an immature voice?

Q-ASC: Research Evaluation: Ormond, Attwood and Garnett 2016

• Completed by parents• 134 males and 100 females• Data analysis revealed eight interpretable and reliable components of

the Q-ASC using Principle Components Analysis (PCA)

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Q-ASC: Research Evaluation

1. Gender identity (5 items)2. Sensory sensitivity (6 items)3. Compliant behaviour (5 items)4. Friendships and play (5 items)5. Social masking (5 items)6. Imagination (5 items)7. Imitation (5 items)8. Talents (2 items) Music and languages

Q-ASC: Research Evaluation• ANOVA between gender and age groups• Statistically significant differences between males and females • Greater reported levels of difficulty for females in the domains of:1. Gender identity (more for 5-12 year olds)2. Sensory sensitivity3. Social masking 4. Imagination 5. Imitation6. Talent in music and languagesNot in compliant behaviour and friendships and play

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Pathways to a Diagnosis for a Teenage Girl• Secondary disorder diagnosed in adolescence, such as:• Anxiety disorder • Depression • Borderline Personality Disorder

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Pathways to a Diagnosis for a Teenage Girl• Eating disorder such as Anorexia

Nervosa (information/rules/sexuality) • Selective mutism• Self-harm • Detailed developmental history

indicates a diagnosis of Asperger’s syndrome

Characteristics from age 5-12 Years

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Affection and Emotions• Indiscriminate and excessive with affection or

extremely shy or defensive against affection• From infancy, extremely intense, inconsolable despair

that lasts a long time and cannot be distracted

Characteristics from age 5-12 Years

Play• Doll play to replay and understand social situations• Real objects, or close copies of real household or life

style items favored over pretend objects• Although it initially looked as though she was playing

with the other girls, she was in fact playing her own game, but in the same place

Characteristics from age 5-12 Years

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Fascination with symmetry and order

“The fun came from setting up and arranging things. Maybe this desire to organize things rather than play with things is the reason I never had any great interest in my peers.”

Characteristics from age 5-12 Years

Gender Specific Toys • I loved playing with Lego for years and had many

thousands as a child. I also loved cardboard boxes, and drawing/writing. I always ignored the dolls I was given.

• Are model aircraft considered ‘toys’? Is there a gender attached to them? I preferred nature or animals to toys.

Characteristics from age 5-12 Years

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Friendships

• Peer support (not bitchy)• Single friend who provides guidance and security• Animals as friends

Choice of Friends• Many stereotypical girls activities were stupid, boring

and inexplicable.• It is more accurate to say that I am gender-neutral. As

a child I liked to play with boys because I enjoyed toy cars, Lego building blocks, sports and that kind of thing, and sadly girls are not often given toys like cars and blocks; also girls were more complicated, and unkind in ways I didn’t understand.

• Boys are more logical. Until their hormones kick in. Then the waters get choppy.

Characteristics from age 5-12 Years

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Choice of Friends• It was easier to identify with boys because they just

wanted to have fun. Girls had more social rules to follow or blunder. They had more gossip and didn’t like to get dirty. The guys were fun and I could almost be myself around them.

• I don’t know how to do girl things. My mother tried to teach me girl things- staying neat and tidy, but I preferred tree climbing, going to the horse track and riding bikes precisely 10 miles a day.

Characteristics from age 5-12 Years

A Tomboy• It was easier to identify with boys because they just

wanted to have fun. Girls had more social rules to follow or blunder. They had more gossip and didn’t like to get dirty. The guys were fun and I could almost be myself around them.

• I don’t know how to do girl things.

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Special Interests“I collect potato mashers. I think I have something over 500, all different. I know other people normally don’t get excited about potato mashers. However, sometimes I can tell from the time they spend looking at some of my potato mashers and how they handle them that they are interested”.

“Most people think my interest in mushrooms is strange”.

Special Interests

• Fashion and make up• Friendship• Interest in autism and Asperger’s syndrome.

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Ultra-feminine or anti-social conventions

• Try to fit in during Primary School by being ultra feminine (pink and frilly)

• In adolescence, when it is not working, the pendulum can swing the other way

• Despise femininity and defy social and gender conventions

• Confusion. Am I a lesbian? Am I gay?

Teens

Teens

• Power of the peer group for self-esteem• In high school, girls treated me like I was something else, not boy, not

girl, just an it• Even though I had support, I felt very alienated inside. Counsellors

chalked this up to teenage angst.

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Clothing and Fashion

• Most of my clothing is gender-neutral. I generally don’t like dresses or skirts and find many of them impractical, too ornamental, and uncomfortable; likewise women’s dress shoes. I usually wear unisex sneakers or brown loafer shoes.

• Nothing feminine or fancy!• Just make sure there are no florals and frilly bits• Fashionable or appropriate clothing adds a further dimension to

social complexity• Few if any friends to go clothes shopping together

Clothing and Fashion

• Girl clothes fit better, but I always try to find androgynous ones.• Guy clothes are generally more practical• I like jeans and shirts because I don’t have to think about what to

wear. Clothes styles don’t really interest me. I feel odd when I dress fashionably and I am not sure whether I am overdressed or underdressed.

• She does not conform to any particular trend but her own

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Employment and Relationships

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Searching for a Job

• Full time or part time?• Application of knowledge and qualifications• Asperger friendly environment• Number of people

Searching for a Job

• Sensory sensitivity• Quality or quantity? – stress levels• Potential for change• Travel to and from work• Application: Disclosure?• Centrelink’s expectations

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Job Interview

• Rehearse, rehearse, rehearse.• Where the interview will take place and travel arrangements• Stress support just prior to the interview• Clothing• Probable questions and answers• What questions to ask• Reading body language for more information or closure• Seeking clarification and whether the question has been answered

Job Interview

• Social and conversational conventions at an interview• Eye contact and non-verbal communication• Portfolio• Disclosure?• How ASD is an advantage in this particular job• Closure

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Starting the New Job

• Mentor at work• Mentor at home• Guidance in the unwritten social rules and personalities• Feedback on work performance• Memory for instructions• Exhaustion at the end of the day• Changes in expectations and responsibilities• Literature: www.jkp.com

Value of Employment

• Self-worth and self-identity• Income• Structure and purpose to the day• Social contact• Anti-dote to depression• All forms of employment from Astronaut to Zoo keeper

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Surviving to Thriving at Work

• A five session programme developed at the Minds and Hearts Clinic in Brisbane

• Each session is half a day. • Workbook, trainers manual, video/audio• Tuition, discussion and role play• Authors Tony Attwood and Michelle Garnett

Content: Pre-Reading

• Pre-course reading and pod-casts on the strengths and challenges of adults with ASD in the work environment

• Information on:• Physical activity• Sleep• Nutrition

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Content: Pre-Reading

• Relaxation and meditation• Social and thinking tools to thrive at work• Energy accounting• Reasons for high levels of depression, anxiety and stress (DASS)• Coping with a meltdown

Content: Pre-Reading

• Pre-course questionnaires on:• Personal strengths and challenges• Sleep• Thinking and learning talents and difficulties• Anxiety and depression

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Session 1 Physical and Relaxation Tools

• Physical and relaxation tools, the emotional and cognitive values• Sleep• Nutrition• Practice with relaxation and meditation activities (audio recording)

Session 2: Social Tools

• Identifying personal qualities. List of positive personality adjectives• The value of the qualities in relationships with customers, clients,

colleagues and manager• Self-esteem and self-identity• Enjoyment of life

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Session 2: Social Tools

• Difficulties with social communication• Accessing social support when you need it• Being able to find and maintain a social life that replenishes you

Session 2: Social Tools

• How to communicate when you are feeling more emotional• Developing scripts and role play for increasing levels of anxiety,

depression, anger or stress to a family member, colleague, line manager

• Communication repair strategies “I’m not sure what you want me to do” or “Am I reading you correctly?”

• Strategies for being bullied, teased and socially rejected

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Session 3: Thinking Tools

• Recognising your thinking styles and strategies for each style:• Black and white (I will always be unemployed)• Overgeneralization (everything will go wrong now)• Magical thinking (superstitious)• Mental filter (focussing on one or two details, not putting the event

in perspective)• Disqualifying the positive (he didn’t mean it, he was just being nice)

Session 3: Thinking Tools

• Jumping to conclusions (impulsive)• Magnification (catastrophizing) and minimization (minimize the

positive, pessimistic)• Emotional reasoning (you think because you feel it, it must be true)• ‘Should’ statements (rigid rules about how people should behave)• Labelling and mislabelling (I am a loser)• Personalization (It was all my fault)

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Session 3:Thinking and Learning Talents

• Long term memory for facts and information

• Being an expert• Originality in problem solving• Inventive• Thinking in pictures• Visual memory• Craftsman

• Repairing things• A particular sport or recreation

activity• Computer games• Talent in the arts such as singing• Drawing• Animation• Creative writing

Session 3: Strategies for Thinking and Learning Difficulties

Knowing and organising what will be needed for the task• Make a list in your notebook of what you need and cross off those items

you have available with you before you commence the activity.• Take a mobile phone photograph of the equipment or resources needed.Estimating how long tasks will take• Ask someone who has done the task before, a colleague or the person that

gave you the instruction or request, how long it will probably take to complete the activity. Alternatively, make of note of each stage of the task and estimate how long it will take to complete each stage, adding the times to estimate how long it will take to complete the whole task.

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Session 3: Strategies for Thinking and Learning Difficulties

Not being distracted by details• Use an app on your mobile phone to make intermittent sounds that

remind you to re-focus on attending to the priority of completing the activity on time.

Remembering spoken instructions• Record the instructions on the audio-recording app on your mobile

phone, or as you listen to the instructions, create in your mind a video of what to do. You may be more able to remember the video than the spoken instructions.

Session 3: Strategies for Thinking and Learning Difficulties

Coping with mistakes• First, do not become distressed. Be calm and thoughtful. Mistakes

happen and do not mean you are stupid or incompetent. Second, try to rectify the mistake, perhaps ask for help and guidance which is the smart thing to do.

Knowing if you are doing a good job• Seek affirmation from your line manage or a colleague, but chose a

time when the person is able to review and comment on your work and is not busy with another activity.

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Session 3: Strategies for Thinking and Learning Difficulties

Completing the activity in the correct sequence• Have a video or audio recording of the sequence of activities and

make a note on your notepad of each component, in sequence. Then cross off each component when completed

Complying with the conventional procedures• Learn the procedures, and have a copy that you can refer to, so that

you can ensure that you have complied with the expected procedures of your employer.

Session 3: Strategies for Thinking and Learning Difficulties

Switching to a new activity before the current activity is completed• Use the metaphor of a train arriving at a station. The train driver must

wait for all the passengers to get off and on the train, before starting the journey to the next station.

Self-reflection and self-monitoring • Try to develop the ability to silently talk to yourself about the activity

as you are completing it. Your inner voice will be similar to a sports commentator on the radio explaining the sports event to the listeners. This will also facilitate concentration and inhibit distraction.

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Session 4: Emotion Management

• Discovering and sharing signs of anxiety, depression and anger• Emotion management strategies from the group leaders and

participants• Sports technology and meditation

Session 5: Creation of a Plan to Thrive

• A personalised manual• Weekly planners to meet the goals of each week• Include the activities and suggestions identified in the previous

sessions• Overcoming barriers to using the Plan to Thrive